scholarly journals Clinical Factors Associated With Cost in Head and Neck Cancer: Implications for a Bundled Payment Model

2019 ◽  
Vol 15 (6) ◽  
pp. e560-e567
Author(s):  
Martin C. Tom ◽  
Richard B. Ross ◽  
Shlomo A. Koyfman ◽  
David J. Adelstein ◽  
Robert R. Lorenz ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Treatment Modalities ◽  
Trimodality Therapy ◽  
Payment Model ◽  
Bundled Payment ◽  
Number Of Treatment

PURPOSE: To determine which factors influence cost in head and neck cancer (HNC) to inform the development of a bundled payment model (BPM). METHODS: Patients with stages 0 to IVB (by American Joint Commission on Cancer, 7th edition) HNC of various sites and histology treated definitively at a single tertiary care center during 2013 were included. Clinical variables and direct cost data were obtained, and their associations were investigated using χ2, t, Wilcoxon rank sum, and analysis of variance testing. Results were used to develop a BPM. RESULTS: One hundred fifty patients were included; 87% were white, 74% were men, 48% had oropharyngeal cancer, and 58% had stage IVA disease. Treatment consisted of surgery alone (17%), radiation alone (11%), surgery plus radiation (14%), chemoradiation (45%), and surgery plus chemoradiation (13%). On multivariable analysis, both increasing group stage and number of treatment modalities used were significantly associated with higher cost. Given that stage often dictates treatment, we developed three cost tiers that were based on overall treatment modality. Tier A, the least costly, consisted of single-modality therapy with either surgery alone or radiation alone (median cost divided by the median overall cost of treatment, 0.54; 25th to 75th percentile range, 0.29 to 1.02), followed by tier B, which consisted of bimodality therapy with either chemoradiation or surgery plus radiation (1.03; range, 0.81 to 1.35), followed by tier C, which consisted of trimodality therapy with surgery plus chemoradiation (1.43; range, 1.10 to 1.96). CONCLUSION: The number of treatment modalities required is the primary driver of cost in HNC. These data can simplify development of a comprehensive HNC BPM.

scholarly journals Prognostic evaluation in head and neck cancer patients: a clinicoimaging tertiary care center study

2021 ◽  
Vol 8 (10) ◽  
pp. 4831
Author(s):  
N. Kavya Keerthika ◽  
D. Sri Veda ◽  
M. P. V. Prabhat ◽  
G. Sarat ◽  
Gunmeet Maini
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Care Center ◽  
Tertiary Care ◽  
World Health ◽  
Treatment Modalities ◽  
Prognostic Evaluation ◽  
Etiological Factors

Background: The occurrence of the head and neck cancers (HNC) is increasing day by day. These have been associated with multiple etiological factors, and early diagnosis has a prime role in the patient's prognosis and overall survival. Prognostic evaluation in head and neck cancer patients utilizing clinical incidence and imaging outcomes.Methods: The study sample included 217 confirmed HNC patients’ data obtained from the tertiary cancer care centre were analysed to assess the prognosis and be subjected to statistical analysis.Results: Out of all HNC, cancer pertaining to the lip and oral cavity was the most common variety with 65.89% and most of the HNC occurred in men of about 97%, suggesting a strong association with adverse oral habits.Conclusions: We conclude that the current scenario of HNC’s progression and treatment modalities in Andhra Pradesh were in comparison to the World Health Organization (WHO) data suggests an increase in the awareness of the etiological factors and the disease progression. Though various advanced imaging and treatment modalities are available, the patients' prognosis is untethered due to low socio-economic status in this region.

Tumor-Infiltrating Lymphocytes in Patients With Advanced Laryngeal Cancer Undergoing Bioselection

2021 ◽  
pp. 019459982110137
Author(s):  
Molly E. Heft Neal ◽  
Joshua D. Smith ◽  
Andrew C. Birkeland ◽  
Catherine T. Haring ◽  
Steven B. Chinn ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Induction Chemotherapy ◽  
Neck Cancer ◽  
Tertiary Care ◽  
Tumor Infiltrating Lymphocytes ◽  
Care Hospital ◽  
Disease Specific Survival ◽  
Infiltrating Lymphocytes ◽  
Disease Specific

Objective Bioselection to assess tumor response after induction chemotherapy has been introduced as an alternative treatment strategy to total laryngectomy for patients with advanced larynx squamous cell carcinoma (LSCC). Tumor-infiltrating lymphocytes (TILs) have proven to serve as prognostic biomarkers in head and neck cancer but have not been evaluated as a way to select patients for treatment paradigms. The aim of this study is to evaluate the role of pretreatment TILs in patients with advanced LSCC undergoing the bioselection paradigm. Study Design Retrospective study. Setting Tertiary care hospital. Methods Patients with advanced LSCC treated with bioselection and available tissue were included (N = 76). Patients were stratified into CD8-low and CD8-high cohorts by using the median TIL count. Kaplan-Meier survival analysis and multivariate cox regression were performed with SPSS version 26 (IBM). Results After controlling for tobacco use, tumor site, and stage, a high CD8 TIL count was an independent predictor of improved 5-year disease-specific survival (hazard ratio, 0.17 [95% CI, 0.03-0.84]; P = .03). CD8 TIL counts did not predict response to induction chemotherapy; however, subgroup analysis of patients treated with chemoradiation therapy revealed that CD8 TIL count was significantly associated with degree of response ( P = .012). Conclusion These findings support prior data published by our group showing that TILs are predictive of disease-specific survival in patients with head and neck cancer. CD8 TIL counts were significantly associated with degree of clinical response after induction chemotherapy. These results suggest that pretreatment assessment of tumor-infiltrating CD8 cells could be useful in selecting patients.

scholarly journals Quantitative Assessment of Serum Magnesium Levels in Head and Neck Cancer: A Tertiary Hospital Based Case Control Study

2021 ◽  
pp. 249-257
Author(s):  
Surender Kumar ◽  
Neha Salaria ◽  
Deepak Verma ◽  
Uma Garg ◽  
Monika Verma
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Case Control Study ◽  
Serum Magnesium ◽  
Tertiary Care ◽  
Case Control ◽  
Control Group ◽  
Control Study

Background- Head and neck squamous cell carcinomas(HNSCC) are one of the most widespread malignancies worldwide. Trace elements such as magnesium are essential at cellular level, and it has been suggested that magnesium plays a role in carcinogenesis. Methods- A hospital based case control study was conducted in a tertiary care medical college with an aim to determine the levels of serum magnesium in patients with head and neck cancer and to  compare  the  levels  of  serum  magnesium  of head and neck cancer patients   with healthy matched control  group  and  derive significance if any. Results- HNSCC was mainly found in males of age group 46 to 55 years. The mean serum Mg value of head and neck cancer patients was 0.71± 0.18 mmol/l while that seen in controls was 0.85± 0.09 mmol/l which was significantly lower(p<0.001). Average serum magnesium levels in stages I, II, III and IV were 0.85, 0.849, 0.682 and 0.554 mmol/l respectively, and a statistically significant association was determined between the two. Conclusion- As the stage of cancer progressed, average magnesium levels decreased congruently, hence establishing that magnesium levels were undeniably correlated to onset as well as progression of HNC. These evidences could be utilized to identify role of magnesium asa potential prognostic biomarker to assess progression of disease or clinical response to various modes of therapy in head and neck cancer patients.

Head and Neck Cancer—A Clinicopathological Study in a Tertiary Care Center

2008 ◽  
Vol 100 (6) ◽  
pp. 690-697 ◽  
Author(s):  
Bukola F Adeyemi ◽  
Lola V Adekunle ◽  
Bamidele M Kolude ◽  
Effiong E.U. Akang ◽  
Jonathan O. Lawoyin
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Clinicopathological Study

scholarly journals Medical Gas Plasma Treatment in Head and Neck Cancer—Challenges and Opportunities

2020 ◽  
Vol 10 (6) ◽  
pp. 1944
Author(s):  
Julia Berner ◽  
Christian Seebauer ◽  
Sanjeev Kumar Sagwal ◽  
Lars Boeckmann ◽  
Steffen Emmert ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Plasma Treatment ◽  
Head And Neck ◽  
Neck Cancer ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Novel Treatment ◽  
Gas Plasma ◽  
Medical Gas ◽  
Physical Plasma

Despite progress in oncotherapy, cancer is still among the deadliest diseases in the Western world, emphasizing the demand for novel treatment avenues. Cold physical plasma has shown antitumor activity in experimental models of, e.g., glioblastoma, colorectal cancer, breast carcinoma, osteosarcoma, bladder cancer, and melanoma in vitro and in vivo. In addition, clinical case reports have demonstrated that physical plasma reduces the microbial contamination of severely infected tumor wounds and ulcerations, as is often seen with head and neck cancer patients. These antimicrobial and antitumor killing properties make physical plasma a promising tool for the treatment of head and neck cancer. Moreover, this type of cancer is easily accessible from the outside, facilitating the possibility of several rounds of topical gas plasma treatment of the same patient. Gas plasma treatment of head and neck cancer induces diverse effects via the deposition of a plethora of reactive oxygen and nitrogen species that mediate redox-biochemical processes, and ultimately, selective cancer cell death. The main advantage of medical gas plasma treatment in oncology is the lack of adverse events and significant side effects compared to other treatment modalities, such as surgical approaches, chemotherapeutics, and radiotherapy, making plasma treatment an attractive strategy for the adjuvant and palliative treatment of head and neck cancer. This review outlines the state of the art and progress in investigating physical plasma as a novel treatment modality in the therapy of head and neck squamous cell carcinoma.

Common head and neck cancer treatment pathways and associated costs in the U.S. commercial managed care population

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17001-e17001
Author(s):  
F. Camacho ◽  
C. D. Mullins ◽  
V. Joish ◽  
J. Choi
Keyword(s):  
Head And Neck Cancer ◽  
Managed Care ◽  
Head And Neck ◽  
Neck Cancer ◽  
Treatment Modalities ◽  
Current Guideline ◽  
Treatment Pathways ◽  
Average Patient ◽  
Single Modality ◽  
The U.S

e17001 Background: For the treatment of head and neck cancer (HNC), different modalities (chemotherapy, radiation, surgery, or chemoradiotherapy) can be used either independently or in combination with others. Information regarding real-world treatment pattern is limited. The purpose of this study was to identify common treatment pathways and associated costs. Methods: The study was performed using data from a large U.S. commercial managed care claims database. Adult subjects (≥18) diagnosed with HNC between January 1, 2006, to December 31, 2006, (index-period) were identified based on a pre-selected ICD-9-CM codes. All subjects were HNC diagnosis-naïve 12 months prior to their index dates (first date of HNC diagnosis) and followed for 12 months post index date. Treatment modalities were identified based on the Healthcare Common Procedure Coding System used in the U.S. Pathways were constructed by reflecting time of and between modality administration claims. Results: 6,570 subjects were identified. The average age was 61 years (±14.9) and 44% (n = 2869) were female. Midwest (31%) and east (31%) region had a higher (p < 0.01) representation, compared to south (20%) and west (18%). Only 2,257 subjects (34%) received some type of treatment modality and were categorized into 20 mutually exclusive treatment pathways. Of these, 82% (n = 1,843) received single modality, 18% (n = 398) received a combination of 2, and 0.7% (n = 16) received a combination of 3 modalities. Among single modality pathways, radiation (34%; n = 619) was most common, however, cheomoradiotherapy (26%; n = 485) had the highest average patient cost ($98,440). Within double modalities, radiation followed by chemotherapy (24%; n = 95) was most common, however, chemoradiotherapy followed by surgery (4%; n = 16) had the highest average cost ($146,374). Within triple modalities, surgery followed by radiation then chemotherapy (50%; n = 8) was most common and costly ($95,868). Conclusions: The most common treatment pathways one year post HNC diagnosis used a single modality; however, the average patient costs within multiple modalities were higher. Further study is required to investigate if these patterns are comparable to current guideline recommendation. [Table: see text]

Viral gene therapy for head and neck cancer

2015 ◽  
Vol 129 (4) ◽  
pp. 314-320 ◽  
Author(s):  
J P Hughes ◽  
G Alusi ◽  
Y Wang
Keyword(s):  
Gene Therapy ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Relevant Literature ◽  
P53 Gene ◽  
Oncolytic Viruses ◽  
Treatment Modalities ◽  
Viral Gene ◽  
Viral Gene Therapy

AbstractBackground:Viral gene therapy is a promising new treatment modality for head and neck cancer. This paper provides the reader with a review of the relevant literature in this field.Results:There are government licensed viral gene therapy products currently in use for head and neck cancer, utilised in conjunction with established treatment modalities. The viruses target tumour-associated genes, with the first licensed virus replacing p53 gene function, which is frequently lost in tumourigenesis. Oncolytic viruses selectively destroy cancer cells through viral replication and can be armed with therapeutic transgenes.Conclusion:Despite considerable advances in this field over the last 40 years, further research is needed to improve the overall efficacy of the viruses and allow their widespread utilisation in the management of head and neck cancer.

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